Alzheimer’s disease makes just about everyone’s short list of aging fears. The disorder robs individuals of their memories…their sense of self…their connection to friends and family. It’s hard on everyone who has to watch their loved one disappear before their eyes.

Now, scientific research published in The Archives of Neurology offers a small—but statistically significant—ray of hope for anyone hoping to prevent Alzheimer’s disease. The answer:  Walking!

The scientists studied 201 healthy adults (ages 45 to 88). The participants were tested for genetic predisposition to Alzheimer’s disease, and were given a brain scan to look for signs of amyloid plaques, the abnormal protein deposits that are a characteristic of the brains of Alzheimer’s patients. Fifty-six participants tested positive for the APOE-e4 gene, a marker that increases the risk of developing Alzheimer’s disease by a factor of 15. None of the participants had signs of Alzheimer’s disease at the beginning of the study. Finally, everyone completed detailed questionnaires about their exercise habits.

According to an article in The New York Times:

The volunteers who reported walking or jogging often — meeting (or, in rare instances, exceeding) the American Heart Association’s exercise recommendation of 30 minutes of moderate or vigorous activity five times a week — had fewer amyloid plaques than the volunteers who reported almost never exercising….

The carriers of the gene who reported walking or jogging for at least 30 minutes five times a week had plaque accumulation similar to that of volunteers who were e4-negative. In essence, the APOE-e4 gene carriers mitigated their inherited risk for developing Alzheimer’s by working out.

So moderate exercise was protective against Alzheimer’s disease…even for people who have an extremely high genetic risk of developing the disease. The scientists have a lot more work to do to figure out why exercise is protective, but for the average person, the take-home lesson is that exercise should become a part of daily health habits for everyone—but especially for those with a family history of Alzheimer’s disease.

“There are so many benefits to exercise,” [Denise Head, an associate professor of psychology at Washington University who led the study] says, “and one may be that it helps the brain” to defend itself against the slow leaking away of memory.

Now that’s science we can get behind!

Charlene Harrington, RN, PhD, FAAN

Results of a new study suggest that the nation’s largest for-profit nursing homes deliver significantly lower quality of care, compared with smaller and not-for-profit nursing homes. Why? Fewer staff nurses (despite profits).

The study looked at quality in the 10 largest for-profit chains, which control about 13% of all nursing home beds in the country. They were choses because of their influence and expansiveness. The researchers from University of California, San Francisco (UCSF) found that when nursing homes put profits ahead of people, they cut costs by reducing the number of staff… especially trained and experienced (but more expensive) staff.

“Poor quality of care is endemic in many nursing homes, but we found that the most serious problems occur in the largest for-profit chains,” said first author Charlene Harrington, RN, PhD, professor emeritus of sociology and nursing at the UCSF School of Nursing. Harrington also is director of the UCSF National Center for Personal Assistance Services.

“The top 10 chains have a strategy of keeping labor costs low to increase profits,” Harrington said. “They are not making quality a priority.”

The correlation is so strong that many experts believe that the best predictor of nursing home care is the number of nurses working at the facility.

Something to remember if you should find yourself looking for a good nursing home.

True or false: All suspicious deaths are investigated so that justice can be done if foul play is discovered.

Answer: It depends on how old you are.

According to an article on the website ProPublica, a nonprofit investigative newsroom, and PBS’s Frontline, if a senior citizen died under suspicious circumstances, there’s no guarantee that anyone will ever investigate. Although it is impossible to know exactly how many suspicious deaths have been signed off as due to natural causes, the evidence uncovered points to a significant problem. When investigators look closely at deaths of elderly people, they discover many cases of mistreatment, abuse, and even murder.

Case in point: 76-year-old Joseph Shepter was living in a nursing home after a stroke paralyzed much of his body and dementia took away his ability to communicate. When he died, the nursing home’s chief medical officer listed the cause of death as heart failure. No one examined the death any further…until a tip from a staffer at the nursing home prompted the state to re-examine the case.

It was discovered that Shepter died of a combination of ailments related to poor care, including infected ulcer, pneumonia, dehydration, and sepsis. In addition, his death was hastened by antipsychotic drugs—drugs he didn’t need. (We have written about the problem of inappropriate use of dangerous antipsychotic medications. To read that blog, click here:  Antipsychotic Drugs Over-Prescribed in Elderly) According to ProPublica:

Dr. Michael Dobersen, a forensic pathologist and the coroner for Arapahoe County, Colo., said he worries about suspicious deaths in nursing homes. “Sometimes, if I don’t want to sleep at night, I think about all the cases that we miss,” Dobersen said. “I’m afraid we’re not looking very hard.”

How Can This Happen?

The reason so many suspicious deaths are overlooked is because of a number of systemic flaws:

And then there is what is arguably the most common reason of all:  Ageism.  According to geriatrician Kathryn Locatell, who specializes in diagnosing elder abuse, it all boils down to ageism. She said, “We don’t value old people. We don’t want to think about ourselves getting old.”

Catherine Hawes, a Texas A&M health-policy researcher who has studied elder abuse for the U.S. Department of Justice, agrees, calling the issue a “hidden national scandal.” She interviewed 40 coroners and medical examiners about how they handled deaths among senior citizens. They told her that they were reluctant to perform autopsies.

“Many of them made the blanket assumption that when an elderly person dies, it must have been because ‘their time had come,’” she said. “But they don’t make that assumption about any other part of the population.”

A Need to Keep Eyes Open

It’s a sad fact that many legislators work to pass laws that reflect their own experiences, which is why it is so difficult to understand why there are so few safeguards for the elderly. We’ve all had parents, grandparents, great-grandparents, and many of them have ended up in nursing homes. Is it that they were among the lucky ones who had perfect care for their loved ones? Or could it be that no one wants to believe that their loved ones were victims who died painful deaths?

For example, Joe Shepter, the son of Joseph Shepter ”used to think that his father ‘died a somewhat peaceful death’ surrounded by caring professionals. Instead, he now believes, his “father was lying in a hospital bed essentially dying of thirst, unable to express himself….”

It’s a difficult thought to have to live with. There’s no going back from something like that. But it is worth knowing. In fact, some communities are developing new strategies for pinpointing suspicious deaths. For example, some counties formed elder death review teams made up of police, prosecutors, adult protective services, the medical examiner, emergency personnel, and others. They are similar to the kinds of teams used by child-abuse investigators. It’s a way to make sure that more than one set of eyes is responsible for looking for signs of abuse.

It’s also a way to make sure that the elderly get justice…eventually, if belatedly.

To read the full article on ProPublica.org, click here:  Gone Without a Case

Of the hundreds of blogs we write each year, the most heartbreaking are those we write about nursing home abuse and neglect. The stories are tragic, and they happen to people who are vulnerable and defenseless. Here is a round-up of the most important nursing home stories of the year. (To read any of the blogs, click on the title and you’ll be taken directly to the story.)

Nursing Home Horror Stories

I am constantly amazed and disturbed by the level of abuse and neglect happening in nursing homes across the country. I talk to people everyday who say they can’t believe that any care facility could actually put residents at risk of harm or death. To give credence to my pessimism, here are some very frightening stories gathered from news articles across the country.

• Nursing Home Tragedies
• Nursing Home Abuse Caught on Hidden Camera
• More Nursing Home Tragedies
• Riverdale’s Nursing Home “Hell”
• More Tragic Nursing Home Stories
• Even More Nursing Home Tragedies
• More Scary Stories About Nursing Home Care

How to Spot Signs of Elder Abuse

Many older people who are abused are at the mercy of their caregivers, and therefore may be afraid to speak about their pain or fear. If you have a loved one in a nursing home, it’s important to remain alert to the signs that something may be wrong.

• Signs of Nursing Home Abuse or Neglect
• “Granny Cam” Captures Images of Abuse

How to Choose a Good Nursing Home

Want to prevent abuse altogether? Start by choosing a quality nursing home.

• Nursing Home Ratings Available

VIDEOS

Early this month we wrote a blog called “Visiting a Loved One in a Nursing Home,” which talked about the nuts and bolts of holiday visits—what gifts to bring, what to check in advance, and when a visit should be delayed.

Today’s blog deals with the more personal side of visiting a loved one in a nursing home or hospital. This advice, from Carol Abaya of The Sandwich Generation, holds true all the time, not just during the holidays.

Advice for a Successful Visit

• For someone who is confined to a nursing home or hospital, time is the best gift you can give. As Carol Abaya says, “Time is the essence of caring. And the physical presence of a close relative can have positive effects on the emotional health of the person being visited.
• Enter the room quietly and talk softly to the patient. While spreading cheer in the rest of the world might mean loud greetings and shouts, people in a nursing home respond better to quiet energy.
• People who are elderly or sick may have a difficult time following complicated sentences or multiple speakers. Let one person talk at a time, and speak in short sentences.
• Don’t interrupt or rush the patient to finish a thought. This can take practice and patience, but it will make the patient feel like an important part of the conversation.
• Talk about positive events in your life…leave complaints, anger, or fear outside. And don’t talk about anyone else’s illness.
• On the other hand, if the patient wants to talk about important but potentially sad topics, join that conversation at the same emotional level. And don’t try to impose false happiness on a difficult situation. For example, people who are dealing with a terminal illness know that they are very sick and they don’t like for visitors to press false optimism.
• If the patient wants to talk about happier memories, encourage it and chime in with memories of your own.
• Don’t feel the need to fill in every moment with chatter. Sometimes just sitting quietly and watching a TV show together can be more valuable to the patient than hours of talk.
• Don’t overstay your visit. For a very sick person, 15 minutes may be enough time. Unless you know the person well and just want to sit quietly in the room, don’t ever plan to stay longer than about 45 minutes. Any longer than that may tire the person too much for the visit to be enjoyable.

To read more information about caring for elderly loved ones, visit The Sandwich Generation.

Good news for disabled and elderly people who require personal care services:  A federal judge has stopped North Carolina from ending services for some Medicaid recipients who receive in-home care.

According to an article in the News & Observer, the state Department of Health and Human Services (DHHS) had recently increased eligibility requirement for personal care services so that recipients would need to demonstrate that they need help with three, instead of two, activities of daily living, such as eating, bathing, or dressing. The requirement was challenged because it only pertained to recipients who receive in-home care; recipients who live in nursing homes still need to demonstrate needing help with only two activities of daily living.

“This is good news,” said Vicki Smith, executive director of Disability Rights North Carolina, one of the groups representing in-home care recipients. “This is a minimum level of service that will make a concrete difference for these individuals and their families.”

The DHHS says that this requirement is part of its efforts to reduce Medicaid fraud and misuse. Still, it seems that it might be easier and more humane to check into individual suspicions of fraud than to eliminate services for thousands of elderly and disabled people. And according to Ms. Smith:

…offering personal care will save money over time. It’s less expensive for the government to pay for personal care for people living in their own homes than it is for 24-hour supervision in adult care homes, she said.

To read the full article in the News & Observer, click here: http://www.newsobserver.com/2011/12/09/1699117/judge-halts-change-to-medicaid.html#ixzz1gLRMvHX5

During the holiday season, nursing homes see an increase in the number of people visiting their loved ones—some estimates say that more people visit in the month of December than in all the other months of the year combined. In order to have the visit go as smoothly and successfully as possible, the Iowa Press-Citizen offers these tips:

• Keep in mind the limitations of the person you are visiting. What are the person’s physical or cognitive limitations? Do they have a limited attention span, or do they tire quickly? If so, plan a shorter visit. If they have trouble recognizing people, it might be too overwhelming if you arrive with a large number of visitors.
• Call ahead. Talk with the resident and the nursing staff to see if some days or times are better or worse than others. Some people with dementia need consistency, and breaking a routine by arriving during mealtime or other activity could be disruptive. Also, some people might have better energy or mood earlier in the day or after an afternoon nap. Better to know what is best for the resident than to have your visit cause problems.
• Consider visiting during mealtime. If your loved one agrees, and if the facility allows, you may want to visit during lunch or dinner. Call the facility in advance to find out the process, how much they charge, and other details. Some residents like being able to introduce family to their nursing home friends while sharing a meal. Alternatively, offer to take your loved one out for a meal.
• Don’t visit if you are sick. While having a cold might not stop you from doing your other daily activities, the elderly have weak immune systems. Something as simple as the common cold could turn into pneumonia, and could actually be fatal for some elderly people. Instead, make the visit by phone, and visit in person when you are totally healthy.
• Even if you are healthy, wash your hands before you enter the facility, and after you leave.
• Bring comfort food. Again, call in advance and speak with both the resident and the nursing staff. The staff can tell you if there are certain foods that are restricted for your loved one’s diet (for example, you wouldn’t want to bring salty foods to a person with high blood pressure), and the resident can tell you which foods he or she particularly likes or dislikes.
• Ask if there are other items you can bring. Nursing home residents can’t just hop in the car and go get anything they want. Your visit could be a lifeline to favorite items, such as lotions, clothing, videos, music, soft blankets, etc. If you bring an item, consider putting the resident’s name on it.
• Ask the resident how he or she would like to spend the time. Consider a hand massage, reviewing a photo album, listening to music, watching a video or TV show together, or making crafts. Some residents will be happy to see the gadgets you have in your pocket (cell phone, ipod, etc.). If you run out of ideas, ask the activities director.
• Connect family members digitally. Call the facility to ask if wireless service is available. If so, you can bring a laptop or iPad to arrange for distant family members to say hello via Skype, FaceTime, or similar services.
• Thank the nursing staff—many are working extra shifts or giving up holiday time with their own families to care for residents.

To read the full article in the Press-Citizen, click here:  Things to Consider When Visiting

Here’s a good news story:

The health-care overall championed by President Barack Obama’s administration has saved Medicare recipients about $1.5 billion since it went into effect in January 2011. This amounts to an average savings benefit to the elderly of about $569 per person.

According to a story on Bloomberg.com:

“Millions of Americans are receiving free preventive services and getting cheaper prescription drugs” because of the health law, said Marilyn Tavenner, the acting CMS [Centers for Medicare and Medicaid Services] administrator, in the statement.

The drug discounts apply to Medicare recipients who reach a coverage gap in the program’s prescription medicine plans called the “donut hole.” The law requires drugmakers to provide a 50 percent discount to people in the gap until they spend $4,550 a year, after which the government covers almost all drug costs.

So far, so good. I want to remain optimistic that these kinds of savings will continue, but there’s a saying:  What goes down, must go back up. Or something like that.

To read the full article, click here:  Bloomberg.com

In May 2011, we told you about an eye-opening statistic that said that nearly one in seven elderly nursing home residents are given power antipsychotic drugs, even though the medicines are dangerous and most of the recipients don’t benefit from these medications. Now, a new article in The Daily News reports that the number may be even higher than that:  Nursing facilities self-report that about 25% of residents received antipsychotic drugs in the third quarter of 2010.

For most of the elderly patients who get the antipsychotics, the drugs—which tend to be sedating—are given to calm disruptive behavior caused by dementia. But antipsychotics don’t treat dementia, and they often have severe side effects. At a hearing of the Senate Committee on Aging, lawmakers were told that instead of inappropriate prescribing, more care should be taken to determine why patients with dementia act up, and then find ways to treat the true underlying condition.

“As the baby boomer generation ages, it is imperative to address the overuse and misuse of antipsychotic drugs among nursing home patients,” said Daniel Levinson, Health and Human Services Inspector General.

We agree with the idea that this issue needs to be addressed, but it is unclear why this is more important for baby boomers than for any other generation. (Daniel Levinson could have been said this better.) This practice of inappropriate use of antipsychotics has been going on for decades:  The same Senate committee issued a report on the misuse of drugs in nursing homes in 1975, and they held a workshop on the topic 20 years ago.

From 1975 to 2011:  That’s a lot of elderly nursing home residents who had to spend the final months or years of their lives in a medication-induced fog. Yes, it is imperative to address the issue. And it is imperative to stop the practice and give elderly patients back their dignity.

Read more: http://www.nydailynews.com/life-style/health/elderly-patients-over-prescribed-anti-psychotic-drugs-concerns-overuse-nursing-home-patients-article-1.985862#ixzz1fiM8yDIa

Among people over age 65, just four types of medications are responsible for 2/3 of all emergency hospitalizations. That’s right: 4 drugs = 67% of hospitalizations due to accidental overdoses or because the medication had a more powerful effect than intended. Wow.

According to an article in The New York Times, the drug classes are:

• Warfarin (also known as Coumadin) is a blood thinner. It accounts for a whopping 33% of emergency hospital visits.
• Insulin injections, which accounts for 14% of hospitalizations.
• Drugs that help prevent blood clotting. These drugs, which include aspirin and clopidogrel, account for about 13% of emergency visits.
• Diabetes drugs known as oral hypoglycemic agents, which account for 11% of hospitalizations.

Despite how common these drugs are, they can be difficult to use correctly—it is a very fine line between a good “effective dose” and a dangerous dose. According to Dr. Dan Budnitz, an author of the study and director of the Medication Safety Program at the Centers for Disease Control and Prevention:

“We weren’t so surprised at the particular drugs that were involved,” Dr. Budnitz said. “But we were surprised how many of the emergency hospitalizations were due to such a relatively small number of these drugs.”

The trick of these medications is that the doses have to be managed within a narrow range that leaves little room for error. For example, insulin is necessary for some people with diabetes, but taking just a little too much could cause insulin shock…and could even be fatal. The blood thinner warfarin is needed by some people to prevent the kinds of blood clots that can cause stroke or heart attacks—too little could cause a stroke…too much could result in uncontrolled bleeding.

“These are medicines that are critical,” Dr. Budnitz said, “but because they cause so many of these harms, it’s important that they’re managed appropriately.”

The bottom-line message is that if you or someone you love is taking one of these Risky Four, make your doctor and pharmacist your best friends. Make sure you totally understand how the drugs work, and how to recognize a potentially serious reaction.

For more information about drug injuries, visit our website at www.lawmed.com. If you have questions, HensonFuerst has answers.